TY - JOUR
T1 - Clinical manifestations of brawny scleritis
AU - Feldon, S. E.
AU - Sigelman, J.
AU - Albert, D. M.
AU - Smith, T. R.
N1 - Funding Information:
Case 1—A 33-year-old white woman in good health was seen in the emergency room of the Massachusetts Eye and Ear Infirmary on Sept. 4, 1961. She had a one-week history of hazy vision in the lower field of her right eye, succeeded by a "curtain" in the superotemporal quadrant of the same eye. She complained of slight right-sided eyebrow ache, as well as generalized muscle pains and occasional paresthesias of the right hand. She had no history of collagen vascular disease. Physical examination revealed stocking-glove hypalgesia on the right side for which no organic cause was found. Examination revealed a visual acuity of R.E.: 6/15 (20/50); L.E.: 6/6 (20/20). The right globe was tender arid 2 mm proptotic. The eyes were white and not inflamed. Binocular indirect ophthalmoscopy revealed a large inferonasal elevation of the right choroid with overlying retinal detachment. The surface of the subretinal elevated mass had a normal choroidal vascular pattern. Visual fields revealed a sloping field defect corresponding to the area of retinal and choroidal elevation. Because the normal choroidal vascular pattern was inconsistent with the diagnosis of intraocular melanoma made on the patient's ad- From the Howe Laboratory of Ophthalmology and the Ophthalmic Pathology Laboratory, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts. This study was supported in part by a grant from the Glorney-Raisbeck Fund of the New York Academy of Medicine (Dr. Sigelman). Dr. Sigelman was a Heed Foundation Fellow (1976-1977). Reprint requests to Taylor Smith, M.D., 243 Charles St., Boston, MA 02114.
PY - 1978
Y1 - 1978
N2 - The authors studied four patients with posterior brawny scleritis. Two underwent enucleation for suspected melanoma, and in the other two, the correct diagnosis was made and effective therapy begun. Of seven other eyes with brawny scleritis from other sources, five were enucleated after diagnosis of choroidal melanoma and one for suspected intraocular tumor. This experience and other previous reports indicate the high incidence of diagnostic confusion regarding brawny scleritis. The authors therefore emphasized clinical symptoms and signs of brawny scleritis: inflammation, tenderness or pain of the globe, history of collagen vascular disease, proptosis, bilaterality, and retinal and choroidal detachment. A preserved normal choroidal vascular pattern over an elevated subretinal mass may be indicative of posterior brawny scleritis. Scleral biopsy is useful for tissue diagnosis. Radioactive phosphorus uptake tests and ultrasonography may erroneously indicate choroidal melanoma and lead to enucleation of a potentially salvageable globe.
AB - The authors studied four patients with posterior brawny scleritis. Two underwent enucleation for suspected melanoma, and in the other two, the correct diagnosis was made and effective therapy begun. Of seven other eyes with brawny scleritis from other sources, five were enucleated after diagnosis of choroidal melanoma and one for suspected intraocular tumor. This experience and other previous reports indicate the high incidence of diagnostic confusion regarding brawny scleritis. The authors therefore emphasized clinical symptoms and signs of brawny scleritis: inflammation, tenderness or pain of the globe, history of collagen vascular disease, proptosis, bilaterality, and retinal and choroidal detachment. A preserved normal choroidal vascular pattern over an elevated subretinal mass may be indicative of posterior brawny scleritis. Scleral biopsy is useful for tissue diagnosis. Radioactive phosphorus uptake tests and ultrasonography may erroneously indicate choroidal melanoma and lead to enucleation of a potentially salvageable globe.
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U2 - 10.1016/S0002-9394(14)78105-X
DO - 10.1016/S0002-9394(14)78105-X
M3 - Article
C2 - 677204
AN - SCOPUS:0017875595
SN - 0002-9394
VL - 85
SP - 781
EP - 787
JO - American journal of ophthalmology
JF - American journal of ophthalmology
IS - 6
ER -